Basic Information
Provider Information | |||||||||
NPI: | 1376831339 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KOSS | ||||||||
FirstName: | ELANA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | POB 1012 | ||||||||
Address2: |   | ||||||||
City: | PORT WASHINGTON | ||||||||
State: | NY | ||||||||
PostalCode: | 110501012 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5166292469 | ||||||||
FaxNumber: | 5166292452 | ||||||||
Practice Location | |||||||||
Address1: | 100 PORT WASHINGTON BLVD. | ||||||||
Address2: | CARDIAC IMAGING | ||||||||
City: | ROSLYN | ||||||||
State: | NY | ||||||||
PostalCode: | 115761347 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5166224556 | ||||||||
FaxNumber: | 5166224551 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2011 | ||||||||
LastUpdateDate: | 06/25/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 262157 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207R00000X | 60 262157 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.